OB Exam 3 Questions

A client with cardiac disease gives birth. Afterward, the nurse assesses the client for signs and symptoms of cardiac decompensation. During the postpartum period, which assessment finding indicates a need for further investigation? SATA a) Heart rate 115 b) Diuresis c) Respiratory rate increase from 16 to 18 over the last two hours d) Uterine pain e) Crackles in the bases of the lungs f) The client reports feeling tired

A and E are correct Diuresis is okay, it's actually good since we are worried about fluid shifts. Expect uterine pain after delivery. Feeling tired is consistent with having a baby. Lethargy or change in LOC status is concerning.

Which drug requires premedication with an antiemetic, antidiarrheal and antipyretic? a) Hemabate/Carboprost b) Trexall/Methotrexate c) Magnesium Sulfate d) Methergine/Methylergonovine

A is correct

Which statement regarding diabetes during pregnancy is correct? a) In the first trimester, estrogen and progesterone stimulate the beta cells in the pancreas to increase insulin production. b) In the second and third trimester, maternal insulin levels are directly proportional to the infant levels. c) Insulin crosses the placenta, but glucose does not. d) Directly after birth of the placenta, the serum glucose is likely to remain elevated for up to six weeks.

A is correct

A patient presents to the emergency department c/o abdominal discomfort. The obstetrician performs an ultrasound and diagnoses a 10 week fetus with positive heart tones located in the ampulla region of the fallopian tube. The nurse understands that the best plan of care for this patient is: a) Surgical removal of the pregnancy b) Dilation and curettage procedure c) Methotrexate administration d) Dilation and extraction procedure

A is correct 10 weeks with signs of heart tones means the fetus is about to start developing rapidly, could rupture so you want to remove it ASAP.

Celestone/Betamethasone is administered in the obstetric population to: a) Increase the level of pulmonary surfactant in the newborn. b) Prevent premature onset of labor. c) Decrease the inflammation process associated with preeclampsia. d) Increase the amount and size of fetal lung tissue.

A is correct A is the best indication, it stimulates surfactant. It is associated with premature onset of labor, but that's not what it is used for. We would use a different steroid for inflammation. The drug doesn't have anything to do with fetal lung tissue.

The nursing priority when a patient is experiencing magnesium toxicity is? a) Discontinue the magnesium. b) Decrease the magnesium. c) Administer calcium gluconate. d) Send a serum Magnesium level.

A is correct If you turn off what's causing the problem, you may not need the antidote.

A nurse is visiting a breastfeeding client at home 2 weeks post-delivery of a 7 pound infant boy via c/s. The lochia is serosa with a midline fundus palpated as firm in the symphysis pubis area. Her nipples are cracked. The client is crying and reports her uterine cramping and niple pain as a 6 out of 10. The baby begins to cry and the mother yells at the infant and says, "YOU ARE A DEMON SPAWN, WHY MUST YOU TORTURE ME OH WICKED CROTCH-FRUIT OF HELL?" What is the nursing priority in this scenario? a) Perform an assessment on the newborn b) Encourage the client to join a postpartum support group c) Educate the client to take Motrin around the clock d) Evaluate the client's latching on and latching off procedures

A is correct No explanation necessary

A nurse is monitoring a client's DTR's who has been on Magnesium Sulfate for 12 hours. Which finding is expected? a) Bilateral DTR's noted as 1+/0 clonus b) Bilateral DTR's noted as 3+/2 beats of bilateral clonus c) Client reports pain and soreness during the DTR exam d) Clonus is elicited when the DTR's are assessed

A is correct Now that she's been on it for a while, we want the clonus gone and her reflexes more tolerable. If the client reports soreness during the DTR exam you are tapping too hard.

A patient is admitted to the labor and delivery unit with vaginal bleeding. To differentiate between placenta previa and placental abruption, the nurse will assess what? a) Abdominal pain b) Fetal heart rate pattern c) Pad counts d) H&H counts

A is correct Placental abruption is very painful, previa is painless. Both can bleed. The FHR tells you how the baby is doing, not what the placenta is doing.

A client has received Methotrexate IM for resolution of ectopic pregnancy. What is the most important follow-up information to impart on this client? a) If you are experiencing sharp unilateral abdominal pain, seek medical care immediately. b) Be certain to avoid pregnancy for a year before taking oral contraceptives. c) Be sure to consume a balanced diet with no restrictions. d) Take your prenatal vitamins and iron for six weeks.

A is correct That is the symptom of an ectopic rupture and is a medical emergency. You wait to tell her B until the molar pregnancy has resolved. Teach her to avoid foods rich in folic acid. Prenatal vitamins have folic acid, which she needs to avoid.

A postpartum woman has been diagnosed with postpartum psychosis. After a month of hospitalization, she is being discharged home today. Which aspect of education should be included in the family teaching plan? a) The woman should never be left alone with the infant. b) Symptoms rarely last more than six weeks. c) The clinical response to medications takes about 3-6 months d) The client will no longer be able to breastfeed due to her multiple complications

A is correct Until we are sure she is out of danger of harming herself or others, she cannot be alone with baby. Meds act sooner than 3-6 months.

A nurse is reviewing the preeclamptic patient's assessment findings and lab values. Which finding would warrant a call to the physician? a) Client reports right upper quadrant pain unrelieved with antacids and pain medicine b) 24 hour urine with a protein level of 200 milligrams c) Frontal headache with a decrease in pain rating with Tylenol (when it persists is bad) d) Urine output of 225 mL over the last 4 hours

A nurse is reviewing the preeclamptic patient's assessment findings and lab values. Which finding would warrant a call to the physician? a) Client reports right upper quadrant pain unrelieved with antacids and pain medicine b) 24 hour urine with a protein level of 200 milligrams c) Frontal headache with a decrease in pain rating with Tylenol d) Urine output of 225 mL over the last 4 hours

A client at 28 weeks gestation is admitted with Placenta Previa, A1DM, and preeclampsia experiences increased bleeding, contractions, and increasing BP. Which orders are appropriate for this client? SATA a) Continuous FHR monitoring b) Celestone/Betamethasone c) Hemabate/Carboprost d) Antibiotics e) Magnesium Sulfate f) Sliding scale insulin

A, B, D, E, and F are correct Betamethasone is for lung maturity. Carboprost is only for abortion or hemorrhage. Antibiotics since she has no GBS screen. Magnesium because she is bleeding and contracting. Insulin because although she is an A1 diabetic which does not require the use of meds, she is getting steroids which will make her blood sugar go up.

In order to be eligible to be discharged home with a diagnosis of placenta previa at 28 weeks gestation, the client must meet all of the following criteria. SATA a) BPP score 8/8 b) NST appropriate for gestational age c) There is a 3 cm area of bright red blood on the peri pad d) The H&H are stable e) The client reports mild pain with her 10 contractions this last hour f) The client has access to reliable transportation and a telephone

A, B, D, and F are correct BPP of 8/8 is perfect. If bleeding is bright red, regardless of amount, it's an active bleed and she can't leave. She shouldn't have more than 6 contractions in an hour, 10 are too many.

A pregnant woman at 34 weeks experiences loss of pulse and respirations. What are the priorities? SATA a) Begin chest compressions and use the CPR release on the hospital bed b) Perform compressions at a rate of 100/minute and 2 rescue breaths c) Monitor the fetus via the external fetal monitor d) Displace the uterus manually e) Perform 60 compressions and 3 rescue breaths f) Use an AED according to protocol and deliver a shock if advised

A, B, D, and F are correct We don't keep a EFM on because if she needs a shock we'll take if off anyway.

A nurse is assessing a client at 34 weeks gestation diagnosed with preeclampsia with severe features and Gestational Diabetes Mellitus. The HCP is considering induction of labor. The client is on the EFM and the strip is interpreted as Category 1. In order to make the most informed decision, the Healthcare Team should consider what? SATA a) HbA1c level b) Amniocentesis c) Kleihauer Betke test d) BPP e) Preeclampsia panel, CBC, and 24-hour urine f) Cord Doppler studies

A, B, E, and F are correct A "could be debated," though it would provide you with more information. If you're considering deliver, an amniocentesis will help check lung maturity. Category I tracing means BPP is unnecessary. A cord Doppler because she has preeclampsia and diabetes, suspect IUGR.

Oxytocin, Magnesium, Insulin, LR, and PCN are ordered for a client at 29 weeks. What are the priorities? SATA a) Use a total of 4 chambers on the pump b) Make sure that all the lines are labeled via the institution protocol c) Use a total of 5 chambers on the pump d) Start two separate IV lines on the client e) Ask for a verification and co-signature of the Oxytocin, Magnesium, and Insulin f) Perform mag checks, blood sugars every hour, and Oxytocin checks every 15 minutes

A, B, E, and F are correct Oxytocin, Magnesium, and Insulin are all high alert so they need their own pump/chamber. All of these are compatible, so no need for separate IV lines.

A client diagnosed with preeclampsia is prescribed bed rest. What improvement in the client's status indicated the bed is having a positive impact? SATA. a) The urine output increase from 50 mL/hour to 100 mL/hour b) The fetal variability increases c) The preeclampsia will resolve in 24-48 hours d) The client will exhibit 2 beats of clonus bilaterally e) The client notes a decrease in her headache pain and scotoma f) The client reports the presence of epigastric pain

A, B, and E are correct A indicates perfusion to vital organs and is an improvement often associated with bedrest. B indicates increased perfusion from the placenta to the baby, which is good. C is wrong because the only cure for preeclampsia is delivery of the placenta, and retained placental fragments may persist. Clonus indicated hyperreflexia and isn't resolved with bedrest, need Magnesium Sulfate. Increased perfusion to the brain would hopefully resolve the headache and help with vision problems. F is a bad sign, no improvement is noted.

A woman at 28 weeks gestation experiences a Sickle cell (vaso-occlusive/acute pain) crisis. The client denies feeling any contractions and her SVE is closed/thick/high. What are the critical nursing interventions? SATA a) Continuous FHR monitoring b) IV fluid administration c) Doxycycline administration d) Magnesium Sulfate administration e) Intravenous patient-controlled analgesia pump f) Administration of fresh frozen plasma

A, B, and E are correct Doxycycline is an antibiotic, didn't mention she had infection. Mag Sulfate is for when she's in labor, there are no contractions. Not enough information for FFP

In the outpatient obstetric setting, consistency in measurement of blood pressure techniques must be maintained to ensure that the nuances in the variations of the BP readings are not the result of provider error. Which techniques are important in obtaining accurate BP readings in the outpatient setting? SATA. a) The client should be seated. b) The client's arm should be placed at the level of the heart. c) An electronic BP device should be used. d) The cuff should cover a minimum of 60% of the upper arm. e) The same arm should be used for every reading.

A, B, and E are correct The client being seated is best. The arm at heart level is considered best practice. You use manual initially, but when you need them frequently you can switch over to electronic. The cuff should ideally cover 75-80% of the arm. And the same arm should be used for consistency.

Which medication is best for the treatment of chronic hypertension during pregnancy? SATA. Generic names are bolded. a) Nifedipine/Procardia (really good for preeclampsia) b) Methyldopa/Aldomet (chronic hypertension with pregnant women) c) Lisinopril/Zestril (don't go for, ACE inhibitors, teratogenic) d) Hydralazine/Apresoline (more for hypertensive crises) e) Magnesium Sulfate f) Labetelol/Nomodyne/Trandate

A, B, and F are correct Lisinopril is an ACE inhibitor, which are teratogenic to pregnant women. Hydralazine is more for a hypertensive crisis. Mag Sulfate is used for seziures.

A client is admitted at 32 weeks with severe preeclampsia and HELLP syndrome. What are the appropriate nursing interventions and provider orders. SATA. a) Blood pressure monitoring every 30 minutes. b) Intermittent fetal heart rate monitoring. c) Deep tendon reflexes and clonus every hour. d) Magnesium Sulfate 6 gram bolus over 30 minutes then 2 grams/hour e) Celestone/Betamethasone 12 mg IM now and repeat in 24 hours. f) Tongue blade taped to the wall.

A, C, D, and E are correct You want BP taken frequently. We want continuous, not intermittent, Fetal heart rate monitoring. Patient's with HELLP syndrome definitely need Magnesium. Since she hasn't made it to 34-36 weeks yet, she needs Betamethasone for fetal lung maturity. Don't use tongue blades ever.

A woman diagnosed with preeclampsia is admitted to the obstetric unit. She begins to experience a seizure. The nurse's primary duty during the seizure is to: SATA. a) Stay with the client and call for help. b) Place the client on the EFM. c) Turn the client to her left side and protect her head. d) Start a Magnesium Sulfate bolus at 6 grams over 30 minutes. e) Insert an oral airway. f) Suction the client's mouth with a Yonker.

A, C, and D are correct Since a seizure is forceful, you won't be able to pick anything on the EFM up, but once the seizure is done you do it. Since she's already having a seizure, you need to deal with that and start this once it's over with to prevent another. Never stick anything in the client's mouth.

Which statement by the client indicates the need for further education regarding the signs of postpartum depression? SATA a) "I will maintain a strict schedule of daily activities." b) "My goal is to take some time for myself every day even if it's only 30 minutes." c) "I will watch for signs of postpartum depression for the next few months." d) "I will ask for help when I am feeling overwhelmed." e) "I will get some extra sleep if I note severe mood fluctuations." f) "I will contact my HCP if I begin to have thoughts of harming myself or others."

A, C, and E are correct Schedule needs some flexibility. Watch for signs of depression at all times, not just next few months. If she has fluctuations we want her to contact her HCP.

A woman at 38 weeks gestation with a history of significant cardiac disease is admitted to labor and delivery. The priority nursing interventions are what? SATA a) Place the client on the EFM b) Recommend a c/s for delivery c) Perform CST d) Administer antibiotics during labor e) Administer Betamethasone f) Minimize Valsalva maneuver during labor

A, D, and F are correct You won't do a c/s on a cardiac patient because she could lose more blood with a c/s in the postpartum period. Vaginal is always ideal. Mom is in trouble, not the baby, so a CST is not necessary. Always administer antibiotics with significant cardiac disease. Don't want to cause significant decompensation with the Valsalva.

A client at 19 weeks gestation with a history of HTN and asthma is diagnosed with a missed abortion. The client says that she would like to resolve the loss as soon as possible, but would also like to bond with the baby. The client is admitted for delivery. What are the best options for this client. SATA. a) Dilation and curettage b) Cytotec/Misoprostol administration c) Oxytocin protocol d) Hemabate/Carboprost administration e) Dilation and evacuation f) Laparotomy

B and C are correct The baby won't come out in one piece with a D&C. Misoprostol can be taken with a history of HTN and asthma, Carboprost cannot however because of bronchospasms. Oxytocin get s the baby out in once piece, but a dilation and evacuation does not. A laparotomy is very invasive and is the last resort.

A nurse is administering a Magnesium Sulfate bolus to a client diagnosed with preeclampsia at 32 weeks. Which finding(s) are expected at this time? SATA a) DTR's will decrease and clonus will resolve in 15 minutes b) Nausea and vomiting c) Decrease in blood pressure by about 20% d) Flushing and feeling hot e) Increase in urine output f) The nurse informs the client that he will return in 15 minutes

B and D are correct 15 minutes is too fast, it takes a while for the medicine to build up. N/V are typical. Magnesium should not have a significant impact on blood pressure, and if it does it might mean toxicity. Flushing and feeling hot are expected. Urine output is from bedrest, a decrease would mean toxicity. You should stay with the client for the first 30 minutes.

A client diagnosed with severe preeclampsia is prescribed Hydralazine 5 mg IV push now for an escalating blood pressure. Her last BP was 180/118. The nurse administers the medication. What is an expected finding after administering the medication? a) The BP will stabilize at 110/60 b) The BP will stabilize at 150/85 c) The client will experience a decrease in her headache, scotoma, reflexes, and epigastric pain d) The client's urine output will increase from 20 mL/hour to 60 mL/hour

B is correct 110/60 may be where we want the BP for a normal person, but a drop that significant would be dangerous and detrimental to the mother and fetus. B is a good enough drop in the recommended range. Magnesium sulfate will help with all the symptoms except epigastric pain. Urine output is more about bedrest and fluid changes.

A patient at 18 weeks gestation has been diagnosed with gestational trophoblastic disease (GTD). In addition to vaginal bleeding, what symptom would the nurse expect to see? a) Severe unilateral pain b) Hyperemesis gravidarum c) Fetal heart tones via Doppler d) Chronic hypertension

B is correct A means one is about to rupture, that is not expected. High levels of hCG cause nausea and vomiting.

A client is one hour status post dilation and curettage. Which finding would warrant further assessment and intervention? a) The client reports her uterine pain as a 4 on a numeric 0-10 scale b) Half of the peri pad is saturated with bright red blood c) Blood pressure is 98/50 and pulse is 88 d) The client reports extreme sadness over the situation and is crying silently

B is correct After a D&C bleeding should be minimal, even half the pad is not good. Want to see trending BP data before you get "bent out of shape." Physical needs met before psychosocial needs.

What is the most important aspect of education for the patient receiving a single dose of IM Methotrexate/Trexall for resolution of ectopic pregnancy? a) Avoid pregnancy for one year b) Follow up in 3-7 days with an OB c) Continue to take prenatal vitamins d) Follow up with an oncologist

B is correct Avoiding pregnancy for one year is a molar pregnancy, not ectopic pregnancy. Prenatal vitamins have folic acid. Oncologists are for cancer, this patient doesn't have cancer.

A patient at 31 weeks gestation diagnosed with a complete placenta previa is being discharged home. Which finding would prevent the patient from going home? a) The patient reports fetal movement 5 times an hour. b) Half of the peri pad is saturated with bright red blood. c) Patient reports feeling 2 mild contractions in the last hour. d) Urine output = 450 mL over the last 8 hours.

B is correct Bright red blood means active bleed, cannot let her go home.

Brisk reflexes, scotoma, and headaches are precursors to which harmful complication associated with pre-eclampsia? a) Decreased tissue perfusion to the liver b) Seizures c) IUGR d) HELLP syndrome

B is correct Brisk reflexes tell you that the body is being excitable, thus leading to possible seizures

During an inpatient psychiatric hospitalization of a client diagnosed with postpartum depression, what is the most important consideration of the visiting schedule with the baby and/or the family? a) Visiting should occur only with the client's significant other b) Supervising and guiding visits with her infant as the client shows improvement in her symptoms c) Allowing no contact with any visitors who cause the client distress d) Having the infant with the mother most of the time

B is correct C is not correct because she does need SOME visitors. If the mother is hospitalized D is not the best answer.

A nurse is obtaining a history on a client who admits to occasionally using cocaine. What is the priority in this situation? a) Suggest that the client terminate her pregnancy b) Refer the client to the social worker for follow-up c) Inform the client that her newborn will be placed in foster care d) Inform the client that a urine sample is needed for a urinalysis and then send the urine for a drugs of abuse panel

B is correct D is wrong because you cannot lie and say you need it for a urinalysis and then use it for something else.

When considering the pathophysiology related to preexisting diabetes, which of the following statements is MOST accurate? a) An increase in maternal hormones during the 1st trimester decreases maternal insulin production. b) The placenta is the major source of insulin resistance in the 2nd and 3rd trimester. c) A decrease in maternal hormones during the 2nd trimester triggers an increased production of insulin. d) Maternal insulin levels are directly proportional to infant levels in the 1st trimester

B is correct First trimester increases insulin production, not decrease. During the 2nd trimester the placenta becomes active, which makes it harder for insulin to function properly. D is just not true.

In order to be eligible to discharge home with a diagnosis of preeclampsia, the client must meet all of the following criteria except? a) Have access to reliable transportation and phone b) The last seizure was 24 hours ago c) Be able to perform and monitor kick counts d) Be able to monitor weight and blood pressure and return if symptoms worsen

B is correct If she just had a seizure she is not going home. The rest are correct.

A client is in labor with a diagnosis of HELLP and DIC. The nurse notes the PT and PTT times are prolonged. Fibrinogen is decreased. What symptoms will the nurse expect to see in this client? a) Variable decelerations b) Petechiae c) Positive Cullen sign d) Patellar reflexes 2+/0 clonus

B is correct It is more likely this condition would lead to late decels or decreased variability, remember VEAL CHOP. Petechiae means you're bleeding with endothelial destruction, and with DIC it's likely that clots of micro structure will congregate.

A G2P1 at 24 weeks gestation is complaining of increased fatigue and dizziness upon ambulation. Which of the following responses best addresses the client complaints? a) Reassure the client this is expected in the 3rd trimester due to increased blood volume b) We need to test your blood to determine the cause for your symptoms c) Have you had a headache recently? d) We need to test your reflexes to determine the cause for your symptoms

B is correct It's likely caused by anemia, so testing the blood is best. Headache and swelling are preeclampsia, which doesn't include dizziness when standing.

A woman has been diagnosed with a ruptured ectopic pregnancy. What is the priority? a) Administer Methotrexate IM b) Bolus the intravenous line with 500-1000 mL of crystalloid fluid c) Assess the abdomen for a Cullen sign d) Perform orthostatic vital signs

B is correct It's too late to preserve ruptured fallopian tube with Methotrexate, you need to bolus and replace the lost fluids. Cullens sign is a late sign. Don't bother with orthostatic vitals, she might pass out.

Which of the following signs/symptoms would the nurse expect to see in the woman with placental abruption? a) Painless vaginal bleeding (placenta previa) b) Increasing abdominal girth c) Fetal heart rate accelerations d) Blood pressure 110/60, pulse 80

B is correct Painless bleeding is placenta previa. Increased abdominal girth means there is concealed internal bleeding.

The team leader nurse is prioritizing care. Which client should the nurse assess first? a) A preeclamptic patient at 28 weeks receiving Magnesium Sulfate at 2 grams/hour complaining of flushing b) A client at 8 weeks who received Amethopterin/Methotrexate 12 hours ago calls in reporting sharp pain on the right side c) A client with placenta previa at 32 weeks who has a decrease in weight on her pad count from an EBL of 200 mL to 50 mL d) A client at 38 weeks on being induced for macrosomia and Type 1 DM has a blood sugar level of 110

B is correct Right sided pain should decrease if the Methotrexate is effective.

A nurse is caring for a client who is being induced with preeclampsia. What finding supports the placement of a Foley catheter? a) The client's DTR's are 1+/0 clonus and the client reports feeling weak b) The client's total urine output over the last 8 hours was 175 mL c) The Magnesium protocol requires that the client not ambulate d) The client needs assistance with getting on the bedpan every 2-3 hours

B is correct Urine output for B is about 22 an hour, which means you want to monitor it closely. C is true, but just because she can't ambulate doesn't mean she can't urinate.

A patient diagnosed with Type 1 diabetes presents to prenatal visit at 20 weeks gestation. The glycosylated HbA1c level was 10% this visit. The nurse knows that many complications can arise with pre-existing diabetes. The most important prenatal testing relevant at this time is: a) Maternal serum glucose b) Fetal echocardiogram c) Non-Stress test d) Glucose Tolerance Test

B is correct We are worried about the development of organs, especially the heart. D is unnecessary because she already has a diagnoses.

Which clients are at the greatest risk or may not have been diagnosed with preeclampsia? SATA. a) A 27 year old client who is pregnant for the second time. She experienced a miscarriage with her first pregnancy. b) A 17 year old client who is pregnant for the first time. c) A 39 year old client who is pregnant for the 5th time. She has a different partner (FOB). Her last delivery was 12 years ago. d) A 29 year old client who was recently diagnosed with IUGR. e) A 25 year old client pregnant at 27 weeks with her second baby. There are no problems noted in her record except GBS is positive

B, C, D, and E are correct A is not a desirable outcome, but Hall said she wouldn't necessary call this a "poor" outcome. B is right because if you've never been pregnant before, we don't know how you're going to respond. C is right because she has a new partner with limited exposure to his sperm. D is right because if she already has IUGR, the vasculature feeding the placenta has something causing that. Other things can, but more than likely it's preeclampsia. E is right because it's an association, if you've got one you're at risk for the other.

What are the goals of Buprenorphine/Subutex or Methadone treatment during pregnancy? SATA a) Wean the client off of all substance use drugs by the third trimester (that's not really the goal, because Subutex and Methadone are opioids and they can be abused as well) b) Treat and prevent the client's withdrawal symptoms (most important aspect of this type of care) c) To assist the client to participate in a controlled medication program d) Prevent intrauterine seizures

B, C, and D are correct Weaning of the drugs is not the goal, because Subutex is an opioid and can be abused as well. Most important aspect of care is preventing withdrawal.

A client presents to the OB triage requesting an ultrasound to determine the sex of her baby. She reports receiving no prenatal care. An ultrasound and NST are performed, but the sex of the infant was not identifiable. The client is estimated to be 39 weeks. A category 1 tracing is verified. What important interventions.assessments are necessary at this time? SATA a) Perform an amniocentesis to determine the gender b) Obtain prenatal labs and GBS swab c) Perform contraction stress test d) Referral to a social worker e) Send a urine drug screen (UDS) f) Perform a SVE

B, D, E, and F are correct We need more medical indications than sex before we perform an amniocentesis. She needs labs since she's never had any.Category I tracing, CST not necessary.

A client diagnosed with DIC has orders for lab values (3 tubes) to be drawn every 4 hours. What is the safest method to obtain the labs? SATA a) From the client's IV site b) Arterial line c) Venipuncture using a butterfly d) Deep intrajugular line e) PICC line

B, D, and E are correct Labs from an IV site may collapse it, would have to waste a lot of mL's before sending it to the lab.

A client diagnosed with severe preeclampsia at 39 weeks. The client is admitted for delivery. The SVE is 3cm/70%/-2. Which orders and nursing interventions are appropriate for this client? SATA a) Foley catheter b) Magnesium bolus 6 grams over 30 minutes c) Celestrone/Betamethasone 12 mgs IM now and repeat in 24 hours d) Continuous FHR monitoring e) Type and hold, hemogram, OB panel, and Magnesium level f) Artificial rupture of membranes

B, D, and E are correct You don't have to put in a Foley right away, only do it if the patient is having a cesarean, she cannot urinate with the bedpan, or her urine output is dropping to less than 30mL/hour. Since the client is 39 weeks, she does not need lung surfactant. She's only -2 station, rupture of membranes is not the priority, wait until she is further along.

There are many associated risk factors in the development of placenta previa. SATA a) Jogger with low body mass index. b) First time mother who smokes 2 packs of cigarettes per day. c) Registered nurse who works 3 busy 12 hour shifts a week on a med-surg floor. d) A client who delivered at 32 weeks SVD with her last pregnancy due to preeclampsia. e) Client pregnant with triplets. f) A client who has a history of two previous c/s.

B, E, and F are correct Jogging is good, low BMI is also good. First time pregnancy and smoking are both risks. Delivering prematurely and preeclampsia aren't significant risk factors. More than one baby and history of surgery (Scar tissue) are risk factors.

The nurse understands that HELLP syndrome can lead to many deleterious effects for the mother and the fetus. SATA. a) Cirrhosis b) Placenta previa c) Placental abruption d) DIC e) Macrosomia f) Seizures

C and D are correct Alcoholics get cirrhosis. It can lead to liver failure, but that's not the same thing. Placental abruption is because of the endothelial cell damage which can lead to vaso-spasticity. DIC occurs especially if the patient has a significant bleeding episode.

Which nursing intervention is important when caring for a substance abusing client? a) Understand that substance use clients are just like any other client and should be treated just the same. b) Assign a nurse who is recovering from substance use disorder to care for the client. c) Treat the client's substance use disorder from the perspective that the disorder is an illness. d) Confront the client about their refusal to attend group sessions and inform them that they may not be placed in a group home if the behavior continues.

C is correct "I don't know if you can treat them the same though, there are certain things we have to take into consideration because of their illness."

Motivational interviewing is an important aspect of guiding therapy and recovery. Which statement best depicts this concept? a) Do you need an eye opener to get your day started? b) Be firm with the client when the client is resistant about attending group therapy c) Affirm the client's ability to turn away visitors who bring in substances of abuse d) Has anyone ever told you about things that you said or did while under the influence that you do not remember?

C is correct A and D are assessment questions for addiction. B is wrong because you don't want to be "firm" with your patient. C puts the power in the client's hands and lets them feel more in control of their care.

A client at 24 weeks of gestation is admitted to the emergency department after sustaining severe internal injuries during a motor vehicle accident. The nurse suspects internal bleeding and placental abruption. The suspicion is verified by which finding: a) Early decelerations are noted on the EFM b) Kleihauer Betke is positive c) Late decelerations are noted on the EFM d) The blood pressure was 110/58 an hour ago and is now 108/56

C is correct A positive Kleihauer Betke is not quite as suspicious as late decels are. Late decels are suspicious with placental abruption because the fetus will show you it's in trouble before the mother does, also with contractions and tachysystole.

A client at 14 weeks is status post cerclage placement in the recovery room. Which finding is most concerning? a) Temperature of 97.6 and the client reports feeling cold. b) The fetal heart rate is 125 and the client denies feeling any movement. c) The client reports some mild lower abdominal cramping. d) There is a 1 cm size spot of pinkish-red discharge on her pad.

C is correct At home or at the hospital, cramping after a cerclage is concerning. A little bit of spotting is okay, but there should be no frank red blood.

A client at 33 weeks gestation has received her morning dose of Methadone. The nurse places the client on the fetal monitor for a NST. After reviewing the NST, the nurse determines the strip is non-reactive. After 2.5 hours, the fetus is reactive. The HCP is contacted. What is the priority recommendation for future NST's? a) Leave the client on the monitor for 1 hours b) Suggest placing the client on Subutex c) The timing of the NST's should occur one hour prior to the next scheduled dose of Methadone d) Recommend a BPP in place of NST testing

C is correct Don't want to change her medication regimen with B. Don't recommend a BPP unless there's like six babies in there.

The priority intervention for a client experiencing Magnesium toxicity is a) Administer Calcium Gluconate b) Notify the HCP c) Discontinue the Magnesium Sulfate d) Use an ammonia capsule under the client's nostrils

C is correct If the patient doesn't respond, then administer the calcium gluconate. Usually turning off and the antidote work before ammonia capsules are needed.

A 25 year old client is admitted at 12 weeks gestation for vaginal bleeding, no fetal heartbeat is seen on ultrasound/ The client is experiencing what type of loss and what is an appropriate treatment? a) Incompetent cervix, cerclage placement b) Missed abortions, amniocentesis (missed abortion wouldn't need an amniocentesis, could allow patient to pass fetus on her own or D&C) c) Inevitable abortion, dilation and curettage d) Incomplete abortion, Cytotec/Misoprostil induction

C is correct Missed abortion wouldn't need an amniocentesis. D is wrong because at 12 weeks if she had a missed abortion, Cytotec is not needed and you'd use a D&C.

A nurse is reviewing the preeclamptic client's assessment findings and lab values. The client is 32 weeks and is receiving Magnesium Sulfate. Which finding would warrant a call to the physician? a) A client reports there is no change in her headache and rates it as a 4/10. b) The 24 hour urine has 200 mg of protein. (rule out because proteinuria is not significant for preeclampsia) c) The AST, ALT, and LDH are all elevated from the labs performed 4 hours ago. (the liver enzyme with epigastric pain) d) The platelet level has dropped from 123,000 to 120,000. (Second best answer)

C is correct Proteinuria is not significant for preeclampsia. The liver enzymes can lead to epigastric pain which is significant. The platelet drop is the second best answer, but the trend is not very steep or significant just yet.

The nurse is performing the initial assessment on a multigravida client at 16 weeks gestation. The client is a 36 year old Hispanic female, BMI 28, and she reports being in good health. The client asks when the screen for gestational diabetes will be done. The nurse responds: a) "You do not need to be screened unless you have a family history of diabetes." b) "You will need a HgA1c drawn today." c) "We will schedule a screening test next visit in four weeks." d) "The screening test will be done between 24-28 weeks gestation."

C is correct The mother has more risk factors like her BMI, ethnicity, and age; therefore she is high risk and we will do one sooner than 24-28 weeks.

A woman G4P0210 is admitted at 12 weeks gestation for cerclage placement. Which of the following long-term outcomes is appropriate for this patient? a) The patient will gain less than 25 pounds during the pregnancy. b) The baby will be classified as appropriate for gestational age at birth. c) The patient will deliver as close to term as possible. d) The patient will now have a normal pregnancy.

C is correct This is what cerclage placement is trying to achieve. Normal is too subjective.

A nurse is reviewing the findings of a three hour oral glucose tolerance test (OGTT) using the two step method. Which of the following is positive for gestational diabetes mellitus? a) A result where the 3-hour result is elevated b) A one hour oral glucose screen is 135 c) The one and two hour results are elevated d) The one hour oral glucose screen is elevated and the fasting level on the GTT is elevated

C is correct You need two elevated tests from the second step, not just one. An elevation in the first step requires follow up for a second step

An insulin dependent diabetic G3 P0200 at 12 weeks gestation is being seen for her prenatal visit. Which finding is most concerning? a) Blood sugar level of 140 two hours after lunch b) HbA1c 6% c) HbA1c 9% d) Fasting blood sugar is 80

C is correct.

10 units of Humalog and 30 units of NPH insulin are due now. To administer the medication correctly, how should the nurse proceed? a) Draw up the Humalog and NPH separately and inject in two separate locations b) Draw up the Humalog first and then the NPH and inject in one location c) Inject air into the Humalog and then the NPH. Draw up the Humalog and then the NPH. Inject in one location. d) Inject air into the NPH, then the Humalog. Draw up the Humalog then the NPH. Inject in one location.

D is correct

A Type 1 diabetic client is at 8 weeks gestation being counseled on her diet during pregnancy. What information is critical in managing the client's blood sugar levels? a) The client should target her pre-meal blood sugar between 100-120 b) The optimal diet includes 40% carbohydrates, 30% fats, and 30% protein c) The total caloric intake should be around 1,500-1,800 calories due to hyperglycemia problems in the first trimester d) The client will need to schedule her meals and snacks without missing any meals throughout the day.

D is correct

Which of the following would the nurse expect to see with a client diagnosed with severe preeclampsia and abnormal Doppler cord blood studies at 35 weeks gestation? a) Maternal blood pressure 140/80 b) Late decelerations c) Urine protein 100 mg in a 24 hour urine collection d) Fundal height measurement 31 cm

D is correct 140/80 is normal for preeclampsia. She might have late decels, but it's not an absolute like the other answers. 100mg proteinuria not a big deal. Dopplers are used to diagnose IUGR, so an abnormal means she has this.

Which client is experiencing magnesium toxicity? a) A client at 29 weeks with a fetal heart rate tracing exhibiting decreased variability over the last 20 minutes. b) A client who experiences flushing and vomiting while receiving a Magnesium bolus. c) A client with no clonus and a 1+ deep tendon reflexes. d) A client who is oriented to person and is confused about where she is.

D is correct A decreased variability over 20 minutes can be tolerated, but if it persists then we would intervene. Flushing and vomiting is expected. C is what we want, those are good outcomes.

Are there any complications for the mother and baby as a result of exposure to preeclampsia and/or Magnesium Sulfate? SATA a) "This is not a concern, we have caught the disease before it had an opportunity to cause long term problems." b) "Infants who are exposed to Magnesium Sulfate during pregnancy are more likely to develop cerebral palsy." c) "All women who are exposed to preeclampsia are more likely to experience DM in the future." d) "Preeclampsia increases your risk for developing chronic hypertension and cardiovascular disease." e) "Magnesium exposure during pregnancy can lead to spasticity of muscles and contractures."

D is correct A is not entirely true. Magnesium is neuroprotective, so B is not true either. While patients with preeclampsia are more likely to already have DM, this does not increase their risk of getting it in the future. Magnesium toxicity can cause muscle spasms, but it is very rare and there are not usually long term problems.

A client presents to the OB triage requesting an ultrasound to determine the sex of her baby. She has not received any prenatal care. An ultrasound and NST are performed. The client is estimated to be 39 weeks. A category I tracing is verified. The client is not in labor. She is discharged with a follow-up appointment for the next day. What important intervention/assessment is necessary before the client leaves? a) A BPP test b) Administer IV antibiotics c) Make sure to inform the client about the sex of her baby d) Send a urine sample for drugs of abuse screen

D is correct C is wrong because of Maslow's hierarchy of needs, address physical before psychosocial. D is correct because she hasn't had prenatal care and we need to screen for drugs. She would also need a social worker.

Which statement by a client 3 weeks postpartum indicates the need to ask about suicidal ideation and a plan? a) "I have lost some weight, but I would like to lose more." b) "I am still experiencing some strong cravings for sweet food." c) "I feel like I have to get up every 2 hours to breastfeed the baby." d) "I have not been able to sleep for over 26 hours."

D is correct It can lead to psychotic thoughts

A woman at 37 2/7 weeks gestation in labor has a history of a class II cardiac disease. The EFM is a category I tracing. The priority nursing intervention is? a) Perform a BPP b) Administer Betamethsone/Celestone c) Administer Methergine/Methylergonovine d) Administer prophylactic antibiotics

D is correct Methylergonovine is only for postpartum hemorrhage or abortion, not during labor. She needs antibiotics because she has class II cardiac disease.

The nurse is discharging a client after delivery and resolution of a molar pregnancy. The most important aspect of teaching to impart to this client is: a) Avoid conception/pregnancy for 3-6 months. b) Using sunscreen while taking Doxycycline/Targadox. c) Follow up with an ultrasound in 6 months. d) Follow up with serial lab values weekly.

D is correct Patient should avoid pregnancy for a whole year. Sunscreen is important, but not most important. An ultrasound will be done before 6 months. Labs show you if the issue is resolving when hCG levels go down

A pregnant woman is being discharged from the hospital after placement of cerclage due to a history of recurrent pregnancy loss secondary to an incompetent cervix. Discharge teaching should emphasize that: a) She will need to make arrangements so that she can be on strict bed rest at home. b) She will need to deliver via c/s. c) The patient will be placed on antibiotics throughout the remainder of her pregnancy d) The presence of any uterine cramping or low back pain should be reported to her health care provider.

D is correct Pelvic rest is recommended, but bed rest doesn't need to be rest of pregnancy. The only time you do a cesarean is if you have an abdominally placed cerclage. She may or may not need antibiotics, but not long term if there are no complications. When the patient feels something with an incompetent cervix, it is significant.

A nurse is assessing a patient on Magnesium Sulfate due to preeclampsia. The nurse knows that the magnesium is effective when? a) The uterine contractions are spacing out. b) The patient's blood pressure is down from 140/90 to 110/58. c) The fetal heart rate variability goes from moderate to minimal. d) The patient's reflexes down from 3+ and 2 beats of clonus bilaterally to 2+ and no clonus.

D is correct Spaced out contractions are when someone has preterm labor contractions, not preeclampsia. Magnesium Sulfate does not lower blood pressure directly, not a good measurement of effectiveness. If FHR goes from moderate to minimal, this could be a sign of toxicity.

Which finding is most concerning if exhibited by a client diagnosed with preeclampsia at 30 weeks gestation? a) Heartburn with nausea and vomiting, client denies RUQ pain b) Blood pressure ranging 130-150/70-90 c) DTR's 3+/0 clonus d) Fundal height measurement of 24 cm for the last two weeks

D is correct This indicates that the baby isn't growing at a normal rate. The other three are expected findings. IUGR is not necessarily associated with preeclampsia, but it is more concerning than the other three answers.

A client begins to experience an eclamptic seizure. What is the nursing priority? a) Administer Valium/Diazepam IV b) Suction the client's PO secretions c) Place the client on the external fetal monitor d) Protect the client's head and displace her uterus to the left

D is correct Valium is usually not administered bu nurses. Don't suction, let the secretions drain on the client's side. EFM as soon as it's over. D is the priority in this situation.

A client diagnosed with HELLP at 28 weeks is being induced with Oxytocin. Magnesium Sulfate is also infusing at 2 grams/hour. The SVE is 1 cm/20%/-1. The contractions are regular. The last platelet count was 50,000 down from 90,000 four hours previous. The client desires an epidural. The anesthesiologist has agreed to place the epidural. What is the nursing priority? a) Advise the client to refuse the epidural as this is an unsafe situation. b) Follow the chain of command in the institution and notify the nurse manager. c) Continue with the plan of care and begin a 1,000 mL fluid bolus to combat hypotension. d) Confer with the anesthesiologist and recommend that coagulation labs be performed.

D is correct We don't know that the epidural is unsafe, we need to do other things first. Do something before you work up the chain of command and get the nurse manager. A bolus would be better supported if you had the labs to back it up. Therefore, D is best to make sure the patient is able to clot effectively.

A nurse is caring for a laboring client at 40 weeks gestation who is a Type 1 Diabetic. The client is placed on an insulin drip. The client's last glucose level is 125. What is the most appropriate nursing action? a) Leave the insulin drip at the current rate b) Decrease the insulin drip per protocol c) Discontinue the insulin drip d) Increase the insulin drip per protocol

D is correct We want it around 100, not much above or below that